PURPOSE: Obesity and its related severe comorbidities are increasing rapidly. The duodenal-jejunal bypass is an endoscopically implanted device (mimicking the Roux-en-Y gastric bypass) developed to support weight reduction and improve type 2 diabetes control. MATERIALS AND METHODS: Retrospective data analysis of consecutive patients undergoing duodenal-jejunal bypass (EndoBarrier®, DJB) implantation between 2013 and 2017 was performed to evaluate safety as well as short- and long-term efficacy. RESULTS: One hundred and twenty-one patients (mean BMI of 43.1 ± 7.2 kg/m2 and weight of 138.2 ± 28.6 kg) underwent DJB implantation. The mean dwelling time was 15.5 months, the mean total body weight loss (%TBWL) after explantation was 10.3% ± 7.9% (14.2 kg, p < 0.0001), and the mean BMI was 39.5 ± 7.3 kg/m2 (p < 0.0001). There was no significant weight gain 24 months after the explantation. Seventy-seven patients had type 2 diabetes mellitus (T2DM) with a mean HbA1c before implantation of 5.6% (n = 52). The mean HbA1c after explantation was 5.1% (p = 0.0001). Significant reductions in transaminase and lipid levels before and after explantation were observed. One complication occurred during implantation and another during explantation. In 16 patients, the device had to be extracted earlier than expected (7 for severe adverse events and 9 for adverse events; 13.2%). CONCLUSION: Despite an evident rate of adverse events, the DJB shows promise as a weight-loss procedure. Our results show that some patients implanted with the device maintained reduced weight even 24 months after explantation, while many improved T2DM control.
- MeSH
- diabetes mellitus 2. typu * chirurgie komplikace MeSH
- duodenum chirurgie MeSH
- glykovaný hemoglobin MeSH
- hmotnostní úbytek MeSH
- jejunum chirurgie MeSH
- lidé MeSH
- morbidní obezita * chirurgie MeSH
- obezita chirurgie komplikace MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- žaludeční bypass * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Incidentální cystické léze pankreatu jsou diagnostikovány se zvýšenou frekvencí v důsledku častějšího používání zobrazovacích vyšetření pomocí počítačové tomografie nebo magnetické rezonance u asymptomatických pacientů, kteří podstupují vyšetření z jiných důvodů. U určitých lézí, jako jsou neuroendokrinní tumory, mucinózní cystadenomy a intraduktální papilární mucinózní neoplazie, existuje významné riziko přítomnosti či vzniku malignity. Endosonograficky navigovaná radiofrekvenční ablace (EUS-RFA) umožňuje selektivní ablaci ložiska pankreatu s minimálním poškozením okolní tkáně a mohla by být alternativní metodou léčby pro pacienty, kteří operaci nechtějí, nebo ji nemohou absolvovat, nebo si nepřejí dlouhodobé sledování. Na základě dostupných pilotních studií se EUS-RFA jeví jako slibná, technicky proveditelná metoda léčby neoplazií pankreatu, která dle dostupných studií prokázala vysokou technickou a přijatelnou klinickou úspěšnost při nízké morbiditě. Sdělení nabízí přehledný souhrn užití EUS-RFA u solidních a cystických neoplazií pankreatu a v závěru popisuje dvě vlastní kazuistiky. V obou případech byla endoskopická léčba technicky proveditelná a nevyskytly se žádné periprocedurální ani postprocedurální komplikace.
Incident cystic lesions of the pancreas are diagnosed with increased frequency due to increased use of CT or MR imaging in asymptomatic patients who undergo imaging for other reasons. Certain lesions such as neuroendocrine tumors, mucinous cystadenomas, and intraductal papillary mucinous neoplasia are at significant risk of the presence or development of malignancy. Endosonographically guided radiofrequency ablation allows selective ablation of the pancreatic lesion with minimal damage to surrounding tissue and could be an alternative treatment modality for patients who do not want or cannot undergo surgery or do not wish to have a long-term follow-up. Based on the available pilot studies, EUS-RFA appears to be a promising technically feasible method for the treatment of pancreatic neoplasia, which has demonstrated high technical and acceptable clinical success rates with low morbidity. This communication offers a clear summary of the use of EUS-RFA in solid and cystic pancreatic neoplasia concluding with two case reports of patients. In both cases, endoscopic treatment was technically feasible and no periprocedural or postprocedural complications occurred.
- MeSH
- intervenční ultrasonografie metody MeSH
- lidé MeSH
- nádory slinivky břišní * chirurgie diagnostické zobrazování MeSH
- neuroendokrinní nádory chirurgie diagnostické zobrazování MeSH
- radiofrekvenční ablace * přístrojové vybavení MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
Stenózy biliární anastomózy patří mezi nejčastější biliární komplikace u pacientů po transplantaci jater. Biliární komplikace jsou spojeny s vyšší letalitou, morbiditou, rizikem selhání funkce štěpu a k léčbě vyžadují zpravidla opakované endoskopické intervence s pravidelnou výměnou stentů. Biodegradabilní stenty jsou novými typy stentů z bio degradabilních polymerů, jejichž hlavní výhodou může být snížení počtu endoskopických intervencí a s nimi spojených komplikací. Cílem našeho článku byl popis případů dvou pacientů po transplantaci jater s časně zjištěnou stenózou biliární anastomózy, která byla řešena endoskopickým zavedením bio degradabilních stentů. V obou případech bylo endoskopické zavedení stentu technicky dobře proveditelné a nevyskytly se žádné periprocedurální ani postprocedurální komplikace. Klinický průběh a kontrolní zobrazení po 8 měsících svědčily pro regresi stenózy u obou pacientů.
Biliary anastomotic strictures are one of the most common biliary complications in patients after liver transplantation. Biliary complications are associated with higher mortality, morbidity, risk of graft failure and usually require repeated endoscopic interventions with regular stent replacement for treatment. Biodegradable stents are new types of stents made of bio degradable polymers, which may have the main advantage of reducing the number of endoscopic interventions and associated complications. The aim of our article was to describe the cases of two patients after liver transplantation with early biliary anastomotic strictures, which were resolved by endoscopic placement of bio degradable stents. In both cases, endoscopic stent placement was technically feasible and there were no periprocedural or postprocedural complications. The clinical course and fol low-up imaging at 8 months showed regression of the strictures in both patients.
- Klíčová slova
- benigní biliární stenózy,
- MeSH
- anastomóza chirurgická * metody MeSH
- cholangiopankreatografie endoskopická retrográdní metody MeSH
- cholestáza * etiologie MeSH
- diagnostické zobrazování metody MeSH
- lidé MeSH
- pooperační komplikace MeSH
- senioři MeSH
- stenty * normy MeSH
- transplantace jater škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND & AIMS: Autoimmune pancreatitis (AIP) is an immune-mediated disease of the pancreas with distinct pathophysiology and manifestations. Our aims were to characterize type 1 AIP in a large pan-European cohort and study the effectiveness of current treatment regimens. METHODS: We retrospectively analyzed adults diagnosed since 2005 with type 1 or not-otherwise-specified AIP in 42 European university hospitals. Type 1 AIP was uniformly diagnosed using specific diagnostic criteria. Patients with type 2 AIP and those who had undergone pancreatic surgery were excluded. The primary end point was complete remission, defined as the absence of clinical symptoms and resolution of the index radiologic pancreatic abnormalities attributed to AIP. RESULTS: We included 735 individuals with AIP (69% male; median age, 57 years; 85% White). Steroid treatment was started in 634 patients, of whom 9 (1%) were lost to follow-up. The remaining 625 had a 79% (496/625) complete, 18% (111/625) partial, and 97% (607/625) cumulative remission rate, whereas 3% (18/625) did not achieve remission. No treatment was given in 95 patients, who had a 61% complete (58/95), 19% partial (18/95), and 80% cumulative (76/95) spontaneous remission rate. Higher (≥0.4 mg/kg/day) corticosteroid doses were no more effective than lower (<0.4 mg/kg/day) doses (odds ratio, 0.428; 95% confidence interval, 0.054-3.387) and neither was a starting dose duration >2 weeks (odds ratio, 0.908; 95% confidence interval, 0.818-1.009). Elevated IgG4 levels were independently associated with a decreased chance of complete remission (odds ratio, 0.639; 95% confidence interval, 0.427-0.955). Relapse occurred in 30% of patients. Relapses within 6 months of remission induction were independent of the steroid-tapering duration, induction treatment duration, and total cumulative dose. CONCLUSIONS: Patients with type 1 AIP and elevated IgG4 level may need closer monitoring. For remission induction, a starting dose of 0.4 mg/kg/day for 2 weeks followed by a short taper period seems effective. This study provides no evidence to support more aggressive regimens.
- MeSH
- autoimunitní pankreatitida * farmakoterapie diagnóza MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- steroidy terapeutické užití aplikace a dávkování MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: Endoluminal radiofrequency ablation (RFA) has been promoted as palliative treatment for patients with cholangiocarcinoma (CCA) and pancreatic ductal adenocarcinoma (PDAC) in order to improve biliary drainage and eventually prolong survival. No high level evidence is, however, available on this technique. DESIGN: In this randomised controlled study, we compared endoluminal RFA plus stenting with stenting alone (control group) in patients with malignant biliary obstruction; metal stents were primarily placed. Primary outcome was overall survival; secondary outcomes were stent patency, quality of life and adverse events. In a superiority design, survival was assumed to be doubled by RFA as compared with 6.4 months in the control group (n=280). RESULTS: A total of 161 patients (male:female 90:71, mean age 71±9 years) were randomised before recruitment was terminated for futility after an interim analysis. Eighty-five patients had CCA (73 hilar, 12 distal) and 76 had pancreatic cancer. There was no difference in survival in both subgroups: for patients with CCA, median survival was 10.5 months (95% CI 6.7 to 18.3) in the RFA group vs 10.6 months (95% CI 9.0 to 24.8), p=0.58)) in the control group. In the subgroup with pancreatic cancer, median survival was 6.4 months (95% CI 4.3 to 9.7) for the RFA vs 7.7 months (95% CI 5.6 to 11.3), p=0.73) for the control group. No benefit was seen in the RFA group with regard to stent patency (at 12 months 40% vs 36% in CCA and 66% vs 65% in PDAC), and quality of life was unchanged by either treatment and comparable between the groups. Adverse events occurred in seven patients in each groups. CONCLUSION: A combination of endoluminal RFA and stenting was not superior to stenting alone in prolonging survival or improving stent patency in patients with malignant biliary obstruction. TRIAL REGISTRATION NUMBER: NCT03166436.
- MeSH
- cholangiokarcinom * MeSH
- cholestáza * etiologie chirurgie MeSH
- katetrizační ablace * škodlivé účinky metody MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory slinivky břišní * komplikace chirurgie MeSH
- nádory žlučových cest * komplikace chirurgie MeSH
- radiofrekvenční ablace * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stenty škodlivé účinky MeSH
- výsledek terapie MeSH
- žlučové cesty intrahepatální chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND & AIMS: Fecal tests currently used for colorectal cancer (CRC) screening show limited accuracy in detecting early tumors or precancerous lesions. In this respect, we comprehensively evaluated stool microRNA (miRNA) profiles as biomarkers for noninvasive CRC diagnosis. METHODS: A total of 1273 small RNA sequencing experiments were performed in multiple biospecimens. In a cross-sectional study, miRNA profiles were investigated in fecal samples from an Italian and a Czech cohort (155 CRCs, 87 adenomas, 96 other intestinal diseases, 141 colonoscopy-negative controls). A predictive miRNA signature for cancer detection was defined by a machine learning strategy and tested in additional fecal samples from 141 CRC patients and 80 healthy volunteers. miRNA profiles were compared with those of 132 tumors/adenomas paired with adjacent mucosa, 210 plasma extracellular vesicle samples, and 185 fecal immunochemical test leftover samples. RESULTS: Twenty-five miRNAs showed altered levels in the stool of CRC patients in both cohorts (adjusted P < .05). A 5-miRNA signature, including miR-149-3p, miR-607-5p, miR-1246, miR-4488, and miR-6777-5p, distinguished patients from control individuals (area under the curve [AUC], 0.86; 95% confidence interval [CI], 0.79-0.94) and was validated in an independent cohort (AUC, 0.96; 95% CI, 0.92-1.00). The signature classified control individuals from patients with low-/high-stage tumors and advanced adenomas (AUC, 0.82; 95% CI, 0.71-0.97). Tissue miRNA profiles mirrored those of stool samples, and fecal profiles of different gastrointestinal diseases highlighted miRNAs specifically dysregulated in CRC. miRNA profiles in fecal immunochemical test leftover samples showed good correlation with those of stool collected in preservative buffer, and their alterations could be detected in adenoma or CRC patients. CONCLUSIONS: Our comprehensive fecal miRNome analysis identified a signature accurately discriminating cancer aimed at improving noninvasive diagnosis and screening strategies.
- MeSH
- adenom * diagnóza genetika MeSH
- kolorektální nádory * diagnóza genetika MeSH
- lidé MeSH
- mikro RNA * analýza MeSH
- nádorové biomarkery analýza MeSH
- průřezové studie MeSH
- sekvenční analýza RNA MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: The presence of isolated elevated serum amylase levels can be caused by high molecular mass complexes. We describe 13 cases of hyperamylasemia detected in adult patients without clinical symptoms of a pancreatic disorder. Five of them were thoroughly examined using different tools for the detection of macrocomplexes. METHODS: We performed both screening and more advanced methods of macroamylase detection, including polyethylene glycol precipitation, sample storage at 4°C and separation by gel filtration. RESULTS: The presence of macroamylase in the suspected samples was confirmed by the methods described, except for the sample storage at 4°C. In this method, the enzyme activity did not decrease. The polyethylene glycol precipitation activity (% PPA) averaged 89.1% for amylase, whereas the control samples averaged 30.7%. Gel filtration chromatography confirmed an IgA macroamylase peak in three samples and an IgG macroamylase peak in two samples. CONCLUSION: The presence of macroamylase should be suspected whenever the clinical history and condition of the patient do not match the measured enzyme value to avoid diagnostic errors and unnecessary invasive examinations. The presence of macrocomplexes is considered a benign process that may occur in apparently healthy individuals. Cooperation between clinicians and laboratory staff is necessary.
- MeSH
- amylasy * MeSH
- chybná diagnóza MeSH
- dospělí MeSH
- gelová chromatografie MeSH
- lidé MeSH
- polyethylenglykoly * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
